Paracetamol for low back pain ‘no better than placebo’

Low back pain affects 44% of the UK population and many millions of people worldwide

Paracetamol used to treat acute lower back pain is no better than a dummy pill, research in the Lancet suggests.

The largest trial to date suggests the drug does not improve recovery time or provide greater pain relief than a placebo.

The study questions whether paracetamol should remain a first-choice drug on most national guidelines.

But experts caution anyone considering a change of medication should seek medical advice.

“Start Quote

Paracetamol does not work for every type of pain, nor does it work for every person”

End QuoteDr Andrew MooreChurchill Hospital, Oxford

About 26 million people suffer from lower back pain each year in the UK, and it remains a leading cause of disability worldwide.

Sleep quality

Researchers studied more than 1,650 people across several primary care centres in Australia, who had experienced back pain for six weeks or less.

A third received regular doses of paracetamol

A third took the drug as needed

A third were given a dummy pill (placebo) for one month

Paracetamol did not reduce the intensity of the pain, nor did it improve sleep quality. And scientists found there was no difference in recovery time for all three groups – an average of 17 days.

Lead author Dr Christopher Williams, from the University of Sydney, said: “The results suggest we need to reconsider the universal recommendation to provide paracetamol as a first-line treatment.”

‘Remain active’

The researchers say the mechanisms behind lower back pain may differ to those in pain felt in other conditions such as headaches, toothaches and post-surgery discomfort – where there is evidence that paracetamol can provide relief.

And as people in the trial recovered more quickly than those in some previous studies, they suggest the advice and reassurance provided during their trial may be more effective than medication.

Dr Andrew Moore, a senior researcher at the Churchill Hospital, Oxford, who was not involved in the research, told the BBC: “Paracetamol does not work for every type of pain, nor does it work for every person.

“There has been evidence emerging for some time that paracetamol does not benefit most people with chronic back pain for example.

“And I’m willing to bet in 10 years’ time national guidelines will have changed.”

However, the researchers were unsure what to recommend instead due the side-effects of some anti-inflammatory pain killers and say people should discuss their options with their doctor.

Prof Roger Knaggs of the British Pain Society, told the BBC: “Despite how common paracetamol use is, this is a question that hasn’t been studied in such a rigorous way before.

“For people who feel no benefit, there are alternative strategies. They should speak to their pharmacists or doctors and discuss any side-effects of other medication.”

Prof Christine Lin, an author on the study, said: “Other ways to ease back pain include remaining as active as possible and avoiding bed rest.”

The Reading Chiropractor can help with low back pain in pregnancy!

It is a common misnomer that low-back pain is normal during pregnancy, however this is not the case. Often underlying problems will lead to pains around the low-back, pelvis and pubis and once these problems have been addressed the symptoms disappear. At the Reading Chiropractor we enjoy treating patients during pregnancy, the benefits and outcomes of which can be dramatic. Pregnancy should not be something to fear and suffer throughout, it should be largely pleasurable, as you build your bonds with your imminent arrival.

Outcomes of pregnant patients with low back pain undergoing chiropractic treatment: a prospective cohort study with short term, medium term and 1 year follow-up

chiropractic care

Background

Low back pain in pregnancy is common and research evidence on the response to chiropractic treatment is limited. The purposes of this study are:

Pregnant patients with low back or pelvic pain, no contraindications to manipulative therapy and no manual therapy in the prior 3 months were recruited.

Baseline numerical rating scale (NRS) and Oswestry questionnaire data were collected. Duration of complaint, number of previous LBP episodes, LBP during a previous pregnancy, and category of pain location were recorded.

The patient’s global impression of change (PGIC) (primary outcome), NRS, and Oswestry data (secondary outcomes) were collected at 1 week, 1 and 3 months after the first treatment. At 6 months and 1 year the PGIC and NRS scores were collected. PGIC responses of ‘better’ or ‘much better’ were categorized as ‘improved’.

The proportion of patients ‘improved’ at each time point was calculated. Chi-squared test compared subgroups with ‘improvement’. Baseline and follow-up NRS and Oswestry scores were compared using the paired t-test. The unpaired t-test compared NRS and Oswestry scores in patients with and without a history of LBP and with and without LBP during a previous pregnancy. Anova compared baseline and follow-up NRS and Oswestry scores by pain location category and category of number of previous LBP episodes. Logistic regression analysis also was also performed.

Results

52% of 115 recruited patients ‘improved’ at 1 week, 70% at 1 month, 85% at 3 months, 90% at 6 months and 88% at 1 year. There were significant reductions in NRS and Oswestry scores (p?<?0.0005). Category of previous LBP episodes number at one year (p?=?0.02) was related to ,improvement’ when analyzed alone, but was not strongly predictive in logistic regression. Patients with more prior LBP episodes had higher 1 year NRS scores (p?=?0.013).

Conclusions

Most pregnant patients undergoing chiropractic treatment reported clinically relevant improvement at all time points. No single variable was strongly predictive of, improvement’ in the logistic regression model.